Feasibility and Early Outcomes of Intraoperative Extubation in Pediatric Atrial and Ventricular Septal Defect Repair via Axillary Thoracotomy.

Q: What are the key findings of this study?

Intraoperative extubation reduced hospital stay compared to ICU extubation after pediatric ASD/VSD axillary thoracotomy repair.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Pediatric atrial septal defect (ASD) and ventricular septal defect (VSD) undergoing repair via axillary thoracotomy (n=61). Intervention: Intraoperative extubation in the operating room (on-table extubation) vs. Postoperative extubation in the intensive care unit (ICU). Primary outcome: Hospital length of stay (days) (p=<0.001).

Q: What does this research mean for the field?

Intraoperative extubation following axillary thoracotomy for pediatric ASD and VSD repair significantly reduces hospital length of stay without increasing reintubation or major complication rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the feasibility, safety, and early recovery outcomes of intraoperative extubation paired with minimally invasive axillary thoracotomy for atrial and ventricular septal defect repair in pediatric patients.

Serkan Seçici; Serkan Terkanlıoğlu

doi:10.21470/1678-9741-2025-0392

July 1, 2026

Feasibility and Early Outcomes of Intraoperative Extubation in Pediatric Atrial and Ventricular Septal Defect Repair via Axillary Thoracotomy.

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Key result

Intraoperative extubation linked to ~1-day shorter hospital stay after pediatric ASD/VSD repair.

P<0.001
n=61

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Why the study?

The feasibility, safety, and early recovery outcomes of intraoperative extubation combined with minimally invasive axillary thoracotomy for pediatric ASD and VSD repair required evaluation.

Does intraoperative extubation shorten hospital length of stay without increasing complications compared to postoperative ICU extubation in pediatric patients undergoing ASD or VSD repair via minimally invasive axillary thoracotomy?

Key Points

To assess the feasibility, safety, and early recovery outcomes of intraoperative extubation paired with minimally invasive axillary thoracotomy for atrial and ventricular septal defect repair in pediatric patients.
Retrospective review of 61 consecutive pediatric patients who underwent ASD (n = 43) or VSD (n = 18) repair via axillary thoracotomy between March 2017 and December 2023.
Patients were grouped by extubation timing into an operating room group (intraoperative extubation) and an intensive care unit group (postoperative extubation).
In the ASD cohort, operating room extubation was associated with a significantly shorter hospital stay compared with ICU extubation (2.78 ± 1.24 vs. 3.60 ± 0.99 days, P < 0.001), with similar ICU stay (1.0 ± 0 vs. 1.05 ± 0.22 days, P = 0.36).
In the VSD cohort, hospital stay was significantly shorter in the operating room group (3.56 ± 0.73 vs. 5.78 ± 3.35 days, P = 0.013), despite these patients having significantly lower body weight (7.39 ± 3.04 vs. 14.08 ± 6.02 kg, P = 0.009).
Across the entire cohort, intraoperative extubation significantly reduced overall hospital stay (3 ± 1.16 vs. 4.28 ± 2.22 days, P < 0.001), with no reintubations in the operating room group and no major complications.

Study Design

Type

Cohort (n=61)

Multicenter

No

Structured PICO

Does intraoperative extubation shorten hospital length of stay without increasing complications compared to postoperative ICU extubation in pediatric patients undergoing ASD or VSD repair via minimally invasive axillary thoracotomy?

P

Population

61 consecutive pediatric patients (63.9% female) undergoing isolated ASD (n=43) or VSD (n=18) repair via minimally invasive right axillary thoracotomy at a single center between March 2017 and December 2023.

E

Exposure

Intraoperative extubation in the operating room (on-table extubation, OTE; n=32 total: 23 ASD, 9 VSD) performed when predefined readiness criteria were met (stable hemodynamics, adequate spontaneous ventilation, satisfactory oxygenation, normothermia, preserved airway protective reflexes), within an enhanced recovery after surgery (ERAS) framework utilizing ultrasound-guided erector spinae plane block (ESPB) and scheduled postoperative paracetamol.

C

Comparator

Postoperative extubation in the intensive care unit (ICU group; n=29 total: 20 ASD, 9 VSD) with the same surgical approach (right vertical axillary thoracotomy) and perioperative analgesic protocol (ESPB plus paracetamol).

O

Outcome

Hospital length of stay (LOS, in days) as an indicator of early postoperative recovery.surrogate

Main Result

Absolute Event Rate: 3% vs 4.28%

p-value: p=<0.001

Intraoperative on-table extubation combined with erector spinae plane block analgesia is feasible and safe in pediatric ASD and VSD repair via minimally invasive axillary thoracotomy, significantly shortening hospital stay even in lower-weight children.

Limitations

Retrospective, single-center design limiting causal inference and generalizability
Relatively small VSD subgroup (n = 18) reducing statistical power
Long-term outcomes such as pulmonary function, musculoskeletal development, and cosmetic satisfaction were not evaluated
Retrospective, single-center design limits causal inference and generalizability
Relatively small VSD subgroup (n = 18) may reduce statistical power

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Implication

Observed shorter stays support exploring intraoperative extubation; leaves open confirmation of safety and benefit in randomized trials.

Abstract

INTRODUCTION: This retrospective study evaluated the feasibility, safety, and early recovery outcomes of intraoperative extubation combined with minimally invasive axillary thoracotomy for atrial septal defect (ASD) and ventricular septal defect (VSD) repair in pediatric patients. METHODS: Sixty-one consecutive pediatric patients who underwent ASD (n = 43) or VSD (n = 18) repair via axillary thoracotomy between March 2017 and December 2023 were included. Patients were categorized by extubation timing into intraoperative (operating room [OR] group) and postoperative (intensive care unit [ICU] group). Baseline characteristics, operative variables, and postoperative outcomes were compared. RESULTS: In the ASD cohort, patients extubated intraoperatively had a shorter hospital stay compared with those extubated in the ICU (2.78 ± 1.24 vs. 3.60 ± 0.99 days, P < 0.001). In the VSD cohort, the OR group included younger and lower-weight patients yet demonstrated a significantly shorter hospital stay (3.56 ± 0.73 vs. 5.78 ± 3.35 days, P = 0.013). Across the entire cohort, on-table extubation was associated with reduced hospital stay (P < 0.001), with no increase in reintubation or major complications. CONCLUSIONS: Intraoperative extubation following axillary thoracotomy for ASD and VSD repair in pediatric patients appears safe and feasible and was associated with a significantly shorter hospital stay, even in lower-weight patients. These findings suggest that intraoperative extubation may be considered as part of enhanced recovery strategies in pediatric congenital heart surgery.

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Cite This Study

Seçici et al. (2026) conducted a cohort in Pediatric atrial septal defect (ASD) and ventricular septal defect (VSD) undergoing repair via axillary thoracotomy (n=61). Intraoperative extubation in the operating room (on-table extubation) vs. Postoperative extubation in the intensive care unit (ICU) was evaluated on Hospital length of stay (days) (p=<0.001). Intraoperative extubation reduced hospital stay compared to ICU extubation after pediatric ASD/VSD axillary thoracotomy repair.

synapsesocial.com/papers/6af0e999de503f3774140a06 https://doi.org/10.21470/1678-9741-2025-0392

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Feasibility and Early Outcomes of Intraoperative Extubation in Pediatric Atrial and Ventricular Septal Defect Repair via Axillary Thoracotomy.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Feasibility and Early Outcomes of Intraoperative Extubation in Pediatric Atrial and Ventricular Septal Defect Repair via Axillary Thoracotomy.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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